How can the man who oversaw Mid Staffs be trusted to shape the health
service’s future?

In less than one month, the NHS will break away from Westminster’s control to be run from new headquarters in Leeds, with Sir David Nicholson at the helm. Describing his qualities last week, the health service’s chairman, Professor Malcolm Grant, announced: “He is the person whose command of the detail of the NHS, and his commitment and his passion to its future, we believe to be fundamental to the success of the [NHS Commissioning] Board.”

How can anyone be said to have “command of the detail” yet overlook more than a thousand deaths at one of the hospitals for which they were responsible? When he faces the health select committee today, Sir David will have some explaining to do.

To miss a catastrophic series of failings at one hospital is bad enough. But we now know that Mid Staffordshire is likely to have been one of many: figures for excess deaths have been massaged to conceal the scale of the problem – and only now are they being thoroughly investigated.

Should the individual who is so personally identified with implementing the NHS’s targets culture, which led to such abysmal care, be charged with putting things right? How can we trust Sir David Nicholson not to be conflicted when dealing with the scale of the carnage in our hospitals? (If you feel carnage is too strong a word, it is worth reading the Francis Inquiry’s report.)

Imagine, for instance, hundreds of deaths occurring in police custody. We would be horrified: heads would roll and prosecutions follow. How can it be that no one has been held to account when this happened on an industrial scale in our hospitals? Arguably, the breaches of trust and dereliction of duty were even graver, as they concerned the care of the most vulnerable.

Robert Francis QC, who chaired the inquiry into Mid Staffs, told the health select committee that he had spent three years of his life “listening in horror”, yet explained that he was able to get to the truth more quickly via an inquiry than would have been possible through a judicial process. That may be true, but an inquiry is only worthwhile if its findings are acted on: Francis has made 290 recommendations, many of which could have a seismic effect upon health-care professionals.

Introducing a statutory duty of candour would have a greater impact on medicine and nursing than any other single recommendation. Had such a duty been in place, prosecutions could have followed from the discovery of abysmal care at Mid Staffs. As it is, even what Mr Francis appeared to regard as a clear case of neglect has been dropped by the Crown Prosecution Service – so there is little hope of justice for other families. That no one has been held to account for so many deaths defies belief.

Care has gone missing from parts of our NHS, yet to say so is considered heresy. A culture that tolerates no narrative other than the NHS being the “envy of the world” has allowed those who complain to be cast as ungrateful and vexatious. Whistleblowers are treated so badly that too many look the other way rather than risk career suicide.

Gagging clauses in the NHS are wholly unacceptable but have been routinely used to silence those who have complained. Vast amounts of public money have been wasted to shield management from scrutiny – and all on Sir David Nicholson’s watch.

David Cameron is in a difficult position, having been so clearly instructed by the Francis Inquiry that there should be no scapegoats. We have been told that this was a system failure that ran from the top right through to the bedside: but Sir David was the person implementing that system. He is famously credited for setting out the “Nicholson Challenge” in 2009, for the NHS to make efficiency savings of around 4 per cent per year.

The horrors of Mid Staffs, however, occurred at a time when the NHS was riding a wave of unprecedented investment. That spending bonanza was so badly planned that hospitals overspent and then struggled to regain financial control, contributing to the disaster. How have politicians and senior managers been allowed to duck their responsibility for such incompetence?

This is a critical moment for the NHS, as it has the opportunity to become clinically led. Will anyone feel confident that its management can break away from business as usual, with the person identified with its worst failings as its chief executive?

The NHS’s chairman, Prof Grant, said last week: “We look, David, to you to provide us with the leadership as we take through an exceptionally challenging set of changes.” That leadership will hang like a dark cloud over the credibility of the new NHS Commissioning Board, which takes up its full statutory duties and responsibilities on April 1. His presence undermines confidence that the board understands the gravity of past failings, let alone has the will to cure them.

The health select committee has no power to fire Sir David Nicholson, but he needs to reflect on the consequences of losing the trust of the public and NHS staff. He may have the myopic confidence of the NHS’s board but that is not enough; the real “Nicholson Challenge” is for someone to make it clear that it is inconceivable for him to continue leading the NHS.

Dr Sarah Wollaston is the Conservative MP for Totnes. She is a former GP and is a member of the health select committee